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Richards O, Gelder C, Nisar S, Wang K, Goodden J, Chumas P, Tyagi A. A comparison of the extent of resection in pineal region tumours via the occipital transtentorial and supracerebellar infratentorial approaches. Br J Neurosurg 2024; 38:568-572. [PMID: 34009093 DOI: 10.1080/02688697.2021.1928601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To perform a single unit review of surgical approaches to the pineal region, looking to ascertain if trends were identifiable regarding the extent of resection and the rate of post-operative complications between approaches. We hypothesised that each approach would offer different exposure of the pineal region which may result in poor access to certain areas of the tumour. This may lead to residual tumour in reliable and predictable locations, and an awareness of these regions could help with pre-operative planning and lead to higher levels of suspicion when inspecting these regions intraoperatively. MATERIALS AND METHODS We performed a single centre, retrospective review of all adult and paediatric patients who underwent surgical debulking of pineal region tumours between 2008 and 2019. Patient demographics, pre- and post- operative radiological tumour volume data, histology and complication rates were compared between the two groups. RESULTS AND CONCLUSIONS The occipital transtentorial approach resulted in a significantly lower extent of resection when compared to the supracerebellar infratentorial approach (p = 0.04), even after multivariate analysis (p = 0.006). There was no significant difference between the location of residual tumour relative to the superior colliculi between the two approaches (p = 1.00). There was a significant incidence of radiological occipital lobe ischaemia from the occipital transtentorial approach (p = 0.04). Within our series, we did not demonstrate a consistent location of residual tumour relative to the surgical approach chosen. Whilst there was a significant difference with regards to the extent of resection between approaches, in the context of small comparative groups this is difficult to draw far-reaching conclusions from.
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Affiliation(s)
- Oliver Richards
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Chloe Gelder
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Saira Nisar
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Kaiwen Wang
- Department of Medicine, University of Leeds School of Medicine, Leeds, United Kingdom
| | - John Goodden
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Paul Chumas
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom
| | - Atul Tyagi
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, United Kingdom
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Hu X, Ren YM, Yang X, Liu XD, Huang BW, Chen TY, Jv Y, Lan ZG, Liu WK, Liu XS, Hui XH, Liu JP, Zhang YK. Surgical Treatment of Pineal Region Tumors: An 18 year-Experience at a Single Institution. World Neurosurg 2023; 172:e1-e11. [PMID: 36167302 DOI: 10.1016/j.wneu.2022.09.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pineal tumor was once considered as a restricted area for surgery. Such cases are rare, with many different opinions on surgical treatment. This study aimed to review our experience of tumor treatment in the pineal region and explore the optimal treatment strategy. METHODS The clinical data of 72 patients with pineal tumors from January 1997 to May 2015 (18 years) were retrospectively analyzed. Preoperative preparation, pathology type, tumor resection rate, surgical approach, and follow-up outcomes were used as the indicators to evaluate the treatment efficacy. RESULTS The Krause approach was used in 46 cases, the Poppen approach in 10 cases, and the transcallosal-lateral ventricle-choroid fissure approach in 16 cases. The postoperative pathological results were as follows: 24 cases of germinoma, 11 of teratoma, 15 of glioma, 6 of meningioma, 11 of Pineocytoma, 2 of cholesteatoma, 2 of cavernous hemangioma, and 1 of choriocarcinoma. Further, the study included 64 cases of total surgical resections, 8 of subtotal resections, and 2 deaths. The follow-up period was from 7 months to 10 years. Further, 51 (70.8%) patients were followed up. The multivariate regression model showed that the surgical method and the pathological type contributed significantly to predicting outcomes. CONCLUSIONS The type of pathology, extent of excision, and surgical approach had a significant impact on the prognosis of patients. The transcallosal-lateral ventricle-choroid fissure approach for large and medium-sized pineal tumors near the posterior part of the third ventricle had good efficacy.
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Affiliation(s)
- Xing Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan-Ming Ren
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiao-Dong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Bo-Wen Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Teng-Yun Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan Jv
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Zhi-Gang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wen-Ke Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xue-Song Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xu-Hui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jing-Ping Liu
- Department of Neurosurgery, The First Xiangya Hospital, Xiangya Medical College, Central South University, Changsha, Hunan, China
| | - Yue-Kang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China.
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Fedorko S, Zweckberger K, Unterberg AW. Quality of life following surgical treatment of lesions within the pineal region. J Neurosurg 2019; 130:28-37. [PMID: 29498568 DOI: 10.3171/2017.7.jns17260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/06/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVEPineal region tumors are a rare and heterogeneous group of lesions. The optimal therapeutic approach is currently a topic of controversy, particularly in light of the potential operative risks and complications. The potential beneficial effects of surgery have already been described, but information about neurological outcome and, in particular, health-related quality of life (HRQOL) is still lacking in the literature. The aim of this study was to assess the therapeutic effect of resection of pineal region lesions, emphasizing grade of tumor resection, neurological outcome, quality of life, and the necessity of additional shunt procedures.METHODSThe authors performed a prospective study of HRQOL in 32 patients who had undergone surgical treatment of lesions in the pineal region (20 tumors and 12 cysts) between 2008 and 2014. All patients had at least 6 months of follow-up, with reexamination including standardized neurological assessment, an evaluation of dependency using the modified Rankin Scale, and an evaluation of HRQOL. The authors retrospectively examined patient charts and collected information regarding imaging studies, neurological status prior to surgery, surgical strategies used, any complications, and histological diagnoses.RESULTSIn this study, there was no surgery-associated mortality or major morbidity. Permanent minor morbidity was reported for 4 patients (13%). Comparing pre- and postoperative neurological symptoms, 75% of tumor patients had either complete resolution or improvement of preoperative symptoms; symptoms were unchanged in 10% of tumor patients and deteriorated in 15%. In patients with pineal cysts, long-term follow-up showed that 42% of patients were free of any symptoms and 58% experienced improvement of their preoperative symptoms. These outcomes were also reflected in the modified Rankin Scale scores, which demonstrated significant improvement following resection of pineal region lesions. Furthermore, significant improvements in HRQOL scores occurred in global health status, in all functional scales, and in pain, nausea and vomiting, fatigue, and insomnia (p < 0.0001). Moreover, a significant reduction in the necessity for permanent shunt procedures was observed after gross-total tumor resection compared with subtotal resection (p = 0.035) of pineal cysts.CONCLUSIONSDespite potential risks, (radical) surgery is a highly effective and safe treatment option for pineal region lesions and should be considered for the majority of patients.
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Choque-Velasquez J, Resendiz-Nieves J, Jahromi BR, Colasanti R, Raj R, Vehviläinen J, Tynninen O, Collan J, Niemelä M, Hernesniemi J. Extent of Resection and Long-Term Survival of Pineal Region Tumors in Helsinki Neurosurgery. World Neurosurg 2019; 131:e379-e391. [PMID: 31369883 DOI: 10.1016/j.wneu.2019.07.169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pineal region tumors represent challenging surgical lesions with wide ranges of survival reported in different surgical series. In this article, we emphasize the role of complete microsurgical resection (CMR) to obtain a favorable long-term outcome of pineal region tumors. METHODS We report a retrospective study of pineal region tumors operated on in Helsinki Neurosurgery between 1997 and 2015. Information was obtained from the hospital records, and an evaluation of the Finnish population register was conducted in July 2018 to determine the current status of the patients. RESULTS A total of 76 pineal region tumors were operated on. The survival was 62% at a mean follow-up of 125 ± 105 months (range, 0-588 months), and the disease-related mortality was limited to 14 patients (18.4%). Up to July 2018, 29 patients had died. Two patients died 1 and 3 months after surgery of delayed thalamic infarctions, 12 patients of disease progression, and 15 had non-disease-related deaths. Only 1 patient was lost in the long-term follow-up. Ten of 14 disease-related deaths occurred during the first 5 years of follow-up: 5 diffuse gliomas, 3 germ cell tumors, 1 grade II-III pineal parenchymal tumor of intermediate differentiation, and 1 meningioma. CMR was linked to better tumor-free survival and long-term survival, with the exception of diffuse gliomas. CONCLUSIONS CMR, in the setting of a multidisciplinary management of pineal region tumors, correlates with favorable survival and with minimal mortality. Surgically treated grade II-IV gliomas constitute a particular group with high mortality within the first 5 years independently of the microsurgical resection.
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Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; Department of Neurosurgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juho Vehviläinen
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Olli Tynninen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Juhani Collan
- Department of Radiation Oncology, Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juha Hernesniemi
- "Juha Hernesniemi" International Center for Neurosurgery, Henan Provincial Peopleás Hospital, Zhengzhou, China
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Qi S, Fan J, Zhang XA, Zhang H, Qiu B, Fang L. Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir (Wien) 2014; 156:2253-62. [PMID: 25246142 DOI: 10.1007/s00701-014-2224-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of radical resection for nongerminomatous pineal region tumors is still controversial. The purpose of this study was to present the surgical results in a large series and evaluate the feasibility of radical surgical strategy. METHODS We retrospectively reviewed the records of 143 patients with nongerminomatous pineal region tumors surgically treated via an occipital transtentorial approach between 2000 and 2011. The tumor was small (<2 cm) in 14.7 % of patients, medium (2-4 cm) in 52.4 %, and large (>4 cm) in 32.9 %. RESULTS Gross total tumor removal was achieved in 91.6 % of patients, subtotal in 7.0 %, and partial in 1.4 %. Histological diagnosis was nongerminomatous germ cell tumor in 41.3 %, pineal parenchymal tumor in 14.7 %, glial tumors in 28.7 %, and miscellaneous in 15.4 %. The overall complication and mortality rate was 18.2 % and 0.7 %, respectively. Permanent morbidity occurred in 5.6 % of patients, including hemianopsia in 3.5 % and Parinaud syndrome in 2.1 %. Hydrocephalus was resolved in 82.1 % without surgery for the CSF diversion. Sixty-eight patients with malignant tumors underwent radiotherapy; 35 also received adjuvant chemotherapy. One hundred thirty patients were successfully followed up with a mean duration of 43 months. Finally, 86.9 % of the patients achieved a favorable functional outcome (mRS ≤ 2), 3.1 % had an mRS score of 3, 1.5 % had an mRS score of 4, and 8.5 % had died (mRS = 6). CONCLUSIONS Radical surgery was recommended as the optimal treatment for nongerminomatous pineal region tumors. Favorable results could be achieved by experienced neurosurgeons. Hydrocephalus could be cured by radical tumor removal in the majority of cases. The occipital transtentorial approach was indicated for most pineal region tumors, but surgeon's preference and experience should also be considered. New understanding of the arachnoid membranes of this region may be helpful for tumor resection.
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Affiliation(s)
- Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Dadao Bei Street, Guangzhou, 510515, People's Republic of China,
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Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A. Falcotentorial and velum interpositum meningiomas: Two distinct entities of the pineal region. Neurol Neurochir Pol 2014; 48:397-402. [DOI: 10.1016/j.pjnns.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 08/27/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Qi ST, Zhang XA, Fan J, Huang GL, Pan J, Qiu BH. Anatomical study of the arachnoid envelope over the pineal region. Neurosurgery 2011; 68:7-14; discussion 14-5. [PMID: 21304334 DOI: 10.1227/neu.0b013e3182059e10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The distribution of the arachnoid membrane and its relationship with the neurovascular structures in the pineal region are still not fully understood. OBJECTIVE Because the arachnoid membrane has an intimate relationship with the neurovascular structures in the pineal region and it will always be encountered surgically, we attempted to clarify the formation and distribution of the arachnoid envelope over the pineal region (AEPG). METHODS The formation and distribution of the AEPG and its relationship with the neurovascular structures in the pineal region were examined by anatomic dissection in 20 adult cadaveric formalin-fixed heads. RESULTS The supratentorial and infratentorial outer arachnoid membranes converged at the tentorial apex and then embraced and ran forward along the vein of Galen to form the AEPG. The AEPG could be divided into 2 parts. Typically, the posterior part of the AEPG enveloped the vein of Galen and the terminal segments of its tributaries, and the anterior part of the AEPG enveloped the suprapineal recess, the pineal gland, and the distal segment of the internal cerebral veins. The compartment demarcated by the AEPG did not communicate with the adjacent subarachnoid cisterns or space. CONCLUSION Previous knowledge about the AEPG, as well as the superior boundary and the contents of the quadrigeminal cistern, needs to be revised. The arrangement and individual variation of AEPG are important for a better understanding of the various growth patterns of the pineal tumors and the relationship between the tumor and the neurovascular structures in the pineal region.
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Affiliation(s)
- Song-tao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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Jia W, Ma Z, Liu IY, Zhang Y, Jia G, Wan W. Transcallosal interforniceal approach to pineal region tumors in 150 children. J Neurosurg Pediatr 2011; 7:98-103. [PMID: 21194293 DOI: 10.3171/2010.10.peds0976] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Pediatric pineal region tumors are very difficult to cure surgically. The authors used the transcallosal interforniceal approach in patients with these lesions. METHODS One hundred fifty children, 98 boys and 52 girls, with pineal region tumors underwent tumor resection via the transcallosal interforniceal approach in the pediatric neurosurgery ward of TianTan Hospital. The patients ranged in age from 1 to 15 years. Fifty-eight patients had mature teratomas; 57, immature teratomas; 14, astrocytomas; 3, glioblastomas; 4, pineoblastomas; 2, pineocytomas; 4, choriocarcinomas; 4, cavernous hemangiomas; 2, germ cell tumors; and 2, epidermoid cysts. RESULTS One hundred twenty-nine tumors were totally removed, 15 were subtotally removed, and 6 were partly removed. There were no deaths and no subsequent instances of disconnection syndrome. Short-term memory deficits appeared in 94 patients but resolved within 6 months in most; only a few patients retained persistent deficits. There were 2 patients with mutism that resolved within 10 days. Parinaud syndrome was observed in 45 patients after surgery; 21 of these cases had appeared preoperatively. The syndrome resolved within 6 months in 31 patients, while it remained in the other 14. CONCLUSIONS The transcallosal interforniceal approach appears to be a safe route for pineal region tumors in children, and complete resection can be achieved in the majority of patients.
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Affiliation(s)
- Wenqing Jia
- Department of Neurosurgery, Tian Tan Hospital, Capital University of Medical Science, Beijing, China
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Bassiouni H, Asgari S, König HJ, Stolke D. Meningiomas of the falcotentorial junction: selection of the surgical approach according to the tumor type. ACTA ACUST UNITED AC 2008; 69:339-49; discussion 349. [PMID: 17707469 DOI: 10.1016/j.surneu.2007.02.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 02/13/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND We retrospectively analyzed a series of patients harboring a FT meningioma with regard to clinical presentation, surgical technique, and follow-up results. METHODS Clinical data in a consecutive series of 13 patients treated for a meningioma of the FT junction were retrospectively reviewed. Tumors were classified into 4 types according to their dural origin and tumor extent as depicted from preoperative MRI. RESULTS Main presenting symptom in 9 women and 4 men (mean age, 56 years) was headache (69%) and gait disturbance (54%). Clinical examination revealed gait ataxia in 62% of the patients. The tumor displaced the vein of Galen inferiorly in 6 patients, superiorly in 2, and medially in 5 cases. The main surgical approach to the meningioma was via an occipital interhemispheric route (10 patients). Additional resection of the falx and/or incision of the tentorium was performed in 6 cases each. A complete resection (Simpson grade 1 and 2) was achieved in 85% of patients. Permanent surgical morbidity was 23%. One tumor recurrence in an atypical meningioma was observed after the mean follow-up period of 6.2 years (range, 1-14 years) with clinical and MRI examination and had to be reoperated. Eighty-five percent of the patients regained full daily activity on follow-up. CONCLUSIONS The surgical approach should be tailored to the dural origin and extent of the tumor as depicted from preoperative MRI. Preservation of the straight sinus and Galenic venous system is recommended.
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Affiliation(s)
- Hischam Bassiouni
- Department of Neurosurgery, University Hospital Essen, 45122 Essen, Germany.
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Stevens QE, Colen CB, Ham SD, Kattner KA, Sood S. Delayed lateral rectus palsy following resection of a pineal cyst in sitting position: direct or indirect compressive phenomenon? J Child Neurol 2007; 22:1411-4. [PMID: 18174563 DOI: 10.1177/0883073807307094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A rare case of delayed lateral rectus palsy in a patient following resection of a pineal lesion in the sitting position is presented. Postoperative pneumocephalus is common following craniospinal surgical intervention in the sitting position. The sixth cranial nerve is frequently injured because of its prolonged intracranial course. A 13-year-old girl was evaluated for unremitting headaches. No focal deficits were demonstrated on neurological examination. Magnetic resonance imaging revealed a cystlike pineal region mass with peripheral enhancement following intravenous contrast administration. A supracerebellar infratentorial craniotomy was performed in the sitting position, and complete resection of the lesion was achieved. Her postoperative course was complicated by sixth nerve palsy on the third postoperative day. Her symptoms improved with conservative management. The occurrence of sixth cranial nerve palsy secondary to pneumocephalus is a rare entity. Even rarer is the report of this anomaly following craniotomy in the sitting position. This patient's symptoms manifested in a delayed fashion. Although uncommon, this complication should be considered in patients undergoing cranial or spinal surgical interventions in this position.
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Affiliation(s)
- Qualls E Stevens
- Section of Neurosurgery, Department of Surgery, Bromenn Regional Medical Center, Normal, Illinois, USA.
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